Thromboangiitis Obliterans (Buerger Disease)
Basics
Description
- One of the causes of critical limb ischemia
- Nonatherosclerotic vasculitis of small- and medium-sized arteries and veins resulting in segmental occlusion of the distal extremity vasculature; caused by inflammatory thrombo-occlusive disease
- Characterized by resting pain, ischemic ulcerations, and gangrene of the digits of hands and feet
- Patients are typically young (age <50 years), male smokers.
- Synonym(s): Buerger disease
Epidemiology
- The prevalence has decreased in North America over the past 30 years.
- Most prevalent in Eastern Europe, Mediterranean, and Asian countries
Incidence
- 11 to 30/100,000 persons per year
- Predominant age: 20 to 40 years
- Predominant sex: male > female; increasingly diagnosed in women, perhaps due to increased smoking
Prevalence
- Estimates range from as low as 0.5–5.5% in Western Europe, to 45–63% in India, to 80% in Israel among those of Ashkenazi ancestry.
- Accounts for 5% and 16% of patients hospitalized for arterial occlusive disease in Europe and Japan, respectively
- 13/100,000 U.S. population
- Overall occurrence is decreasing worldwide.
Geriatric Considerations
Not common in the elderly
Pediatric Considerations
Consider in adolescent smokers presenting with claudication, digital ulcers, or digital gangrene; rare in children
Etiology and Pathophysiology
- Thromboangiitis obliterans (TAO) is idiopathic in nature. Demonstrates impaired endothelium-dependent vasorelaxation and decreased peripheral sympathetic outflow. Nonendothelial mechanisms of vasodilation are intact.
- Segmental infiltration of inflammatory cells in vessel wall leads to thrombotic occlusion.
- Highly cellular and inflammatory thrombus with relative sparing of the blood vessel wall
- Smoking predisposes to occurrence.
- Genetic factors implicated
- Autoimmune component which is not fully understood
- Chronic anaerobic periodontal infection
Genetics
- Greater prevalence of HLA-A54, HLA-A9, and HLA-B5
- HLA-B12 antigen may be associated resistance to disease.
- Familial cases rarely reported
Risk Factors
- Smoking as little as 1 to 2 cigarettes daily, chewing tobacco, snuff, and nicotine replacement are all risk factors for TAO.
- Chronic anaerobic periodontal infection also may play a role in the development of TAO.
General Prevention
Tobacco cessation
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Citation
Domino, Frank J., et al., editors. "Thromboangiitis Obliterans (Buerger Disease)." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116597/all/Thromboangiitis_Obliterans__Buerger_Disease_.
Thromboangiitis Obliterans (Buerger Disease). In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116597/all/Thromboangiitis_Obliterans__Buerger_Disease_. Accessed November 5, 2024.
Thromboangiitis Obliterans (Buerger Disease). (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116597/all/Thromboangiitis_Obliterans__Buerger_Disease_
Thromboangiitis Obliterans (Buerger Disease) [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 November 05]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116597/all/Thromboangiitis_Obliterans__Buerger_Disease_.
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